MCL1 participates in leptin-promoted mitochondrial fusion and contributes to drug resistance in gallbladder cancer

Obesity is a risk factor for gallbladder cancer (GBC) development and correlates with shorter overall survival. Leptin, derived from adipocytes, has been suggested to contribute to the growth of cancer cells. However, the detailed mechanism of leptin in GBC drug resistance remains uninvestigated. In this study, it is clinically relevant that GBC patients with a higher BMI (BMI ≥ 24 kg/m2) (n=30) were associated with increased GBC risks, including survival. Moreover, obese NOD/SCID mice exhibited a higher circulating concentration of leptin, which is associated with GBC growth and attenuated gemcitabine efficacy. We further revealed that leptin can inhibit gemcitabine-induced GBC cell death through myeloid cell leukemia 1 (MCL1) activation. The transcription factor CCAAT/enhancer-binding protein delta (CEBPD) is responsive to activated signal transducers and activators of transcription 3 (pSTAT3) and contributes to MCL1 transcriptional activation upon leptin treatment. In addition, MCL1 mediates leptin-induced mitochondrial fusion and is associated with GBC cell survival. This study suggests the involvement of the pSTAT3/CEBPD/MCL1 axis in leptin-induced mitochondrial fusion and survival. It provides a new therapeutic target to improve the efficacy of gemcitabine in GBC patients.